☰ Table of contents
Recommendations: Early detection of prostate cancer
Preventive intervention type
Who is at risk?
What should be done?
Level/ strength of evidence
|Asymptomatic men at average risk
|Population-based screening is not recommended. If patients request information, discussion needs to provide information of risks and benefits of prostatespecific antigen (PSA) testing to allow an informed decision
Consider using a decision aid tool to facilitate these discussions (refer to ‘Resources’)
|Population screening not recommended. For male patients aged 50–69 years who request information and screening, consider PSA testing every two years after obtaining informed consent
|Asymptomatic men at potentially higher risk due to family history
|Recommend individualised discussion with patient based on assessment of risks and benefits
If requested, following these discussions, consider PSA testing from age 40 or 45 years, depending on risk of patient (refer to clinical practice guidelines in ‘Resources’ for risk estimates and recommendations)
Prostate cancer is the fourth most common cancer diagnosed in Aboriginal and Torres Strait islander peoples. The age-standardised incidence of prostate cancer in Aboriginal and Torrres Strait Islander men was estimated to be 30% less than for non-Indigenous men, with no difference in mortality rate. Missing data on Aboriginal and Torres Strait Islander status was estimated in around 15% of prostate cancers.3
Factors that may indicate an increased risk of prostate cancer are multiple blood relatives having prostate cancer, especially if they are first-degree relatives (father, brother, son); if cancer was diagnosed earlier than 55 years in the family member; and if, in addition to prostate cancer, there is a family history of other cancers.
There are specific gene mutations that are known to increase the risk, such as being a carrier of BRAC1 or BRCA2 mutations.113–116
Individual discussion if requested about prostate cancer risk
Measuring prostate-specific antigen (PSA) with or without digital rectal examination (DRE) is not recommended for asymptomatic population screening for prostate cancer due to the risk of false positive results, risk of harm from investigations, risk of overdiagnosis and unnecessary treatment of a slow-growing cancer that may have had no impact on quality or length of life. Men who are concerned about their risk of prostate cancer should discuss this with their doctor. Doctors should help such men to make a fully informed decision whether or not to commence regular PSA screening – DRE screening is no longer recommended. Use of a decision support tool, such as The Royal Australian College of General Practitioners’ tool for men aged 50–69 years (refer to ‘Resources’),124 may be helpful.117
Men with urinary symptoms should consult their doctor for appropriate investigation and management.